Interesting Finding About Surgical Checklists Points the Way Toward a New Research Agenda
Atul Gawande’s book The Checklist Manifesto took the world by storm. The fact that something as simple as a surgical checklist could save lives transformed the way people thought about not just medicine but every other facet of life. That’s why it was so troubling when, in a study run by Gawande’s team in the Indian state of Uttar Pradesh, the checklist didn’t work.
In the New York Times Magazine, Siddhartha Mukherjee, another leading health writer (author of Emperor of All Maladies: A Biography of Cancer) dug into what happened in Gawande’s India study and what it means. (Gawande himself wrote an excellent piece in the New Yorker on the same subject).
It turns out that despite an intensive peer-coaching program, not enough health workers adopted the behaviors included in the checklist. For example, only 35 percent of birth attendants who received coaching washed their hands before conducting procedures, even though handwashing was one of the items on the checklist. According to Mukherjee, “features unique to labor and delivery in obstetric hospitals in India may have made checklists ineffective”—including the possibility that the checklist competed with a long-established body of local knowledge for precedence.
The larger point is “the extent to which human behavior remains an uncharted frontier for medicine.” This is one of the reasons we’re excited about Ki’s geographically focused work in Brazil and India: it promises to generate context-specific insights that we can compare and contrast to start developing hypotheses related to human behavior as well as human physiology. Ultimately, it is the blend of all these hypotheses that will save the most lives.